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Why do so few patients with heart failure participate in cardiac rehabilitation? A cross-sectional survey from England, Wales and Northern Ireland
  1. Hasnain M Dalal1,
  2. Jennifer Wingham2,
  3. Joanne Palmer2,
  4. Rod Taylor3,
  5. Corinna Petre4,
  6. Robert Lewin4 on behalf of the REACH-HF investigators
  1. 1Peninsula Medical School (Primary Care), Truro, Cornwall, UK
  2. 2Research Unit, Research and Development, Royal Cornwall Hospital, Truro, Cornwall, UK
  3. 3Peninsula Medical School (Primary Care), University of Exeter, Exeter, UK
  4. 4BHF Care and Education Research Group, University of York, York, UK
  1. Correspondence to Dr Hasnain M Dalal; hmdalal{at}


Objectives To determine why so few patients with chronic heart failure in England, Wales and Northern Ireland take part in cardiac rehabilitation.

Design Two-stage, postal questionnaire-based national survey.

Participants and setting Stage 1: 277 cardiac rehabilitation centres that provided phase 3 cardiac rehabilitation in England, Wales and Northern Ireland registered on the National Audit of Cardiac Rehabilitation register. Stage 2: 35 centres that indicated in stage 1 that they provide a separate cardiac rehabilitation programme for patients with heart failure.

Results Full data were available for 224/277 (81%) cardiac rehabilitation centres. Only 90/224 (40%) routinely offered phase 3 cardiac rehabilitation to patients with heart failure. Of these 90 centres that offered rehabilitation, 43% did so only when heart failure was secondary to myocardial infarction or revascularisation. Less than half (39%) had a specific rehabilitation programme for heart failure. Of those 134 centres not providing for patients with heart failure, 84% considered a lack of resources and 55% exclusion from commissioning contracts as the reason for not recruiting patients with heart failure. Overall, only 35/224 (16%) centres provided a separate rehabilitation programme for people with heart failure.

Conclusions Patients with heart failure as a primary diagnosis are excluded from most cardiac rehabilitation programmes in England, Wales and Northern Ireland. A lack of resources and direct exclusion from local commissioning agreements are the main barriers for not offering rehabilitation to patients with heart failure.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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  • To cite: Dalal HM, Wingham J, Palmer J, et al. Why do so few patients with heart failure participate in cardiac rehabilitation? A cross-sectional survey from England, Wales and Northern Ireland. BMJ Open 2012;2:e000787. doi:10.1136/bmjopen-2011-000787

  • Contributors RL and RT conceived the original idea of conducting the survey. HMD, RT, RL and JP wrote the paper. The survey questionnaires were designed by the BHF Care and Education Research Group at York and the REACH-HF Study Group and administered by CP via the National Audit of Cardiac Rehabilitation office in York and by JW and HMD in Truro. CP and JP were involved in collating the data and data input. JP and RT analysed the data. HMD and RL are joint guarantors for this study. The REACH-HF investigators include the authors HMD, RL, RT and JW, as well as Patrick Doherty, Kate Jolly, Russell Davis, Sally Singh, Jackie Austin, Robert Williams, Colin Green, Colin Greaves, Robin van Lingen, Lorna Geach and John Packard.

  • Funding This study was supported by a Programme Development Grant (RP-DG-0709-10111) from the National Institute for Health Research (NIHR). The views expressed in this publication are those of the authors and not necessarily those of the NHS, NIHR or Department of Health.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The Excel spreadsheets with responses from the stage 1 and stage 2 surveys and the data supplied by the National Audit of Cardiac Rehabilitation for this study will be placed in the Dryad repository and readers can access this via the DOI:10.5061/dryad.n6661sh1. The demographic data from the centres are anonymous and the risk of identification of individual centres is low.

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